Healing starts here. Let's do this together!

Let’s start with an easy one, how did you hear about us? *

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Google Results

Friend/Family/Doctor

Facebook (@ahchope)/Instagram (@ahchope20)

Attended Event or Saw Event Online

Drive Past Office

Other

Are you submitting information for yourself or someone else (if someone else, specific if for child, couple, or family in the next question)? *

Myself
Someone Else
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Please provide the following information for any client other than yourself: Legal Name, Date of Birth, E-mail Address. IMPORTANT: Enter your information in the follow prompts even if not the client.

First Name *

Last Name *

Email *

Phone *

Date of birth *

If comfortable sharing, what’s motivating you to seek therapy?

Do you plan to use insurance or private pay? *

Anthem BCBS

United/Optum

Cigna

Aetna

Lyra Benefits

Private pay ($100/hr or $120 for couples/family) We only do true couples/family therapy via private pay & take a $50 deposit upon scheduling the appointment.

Note: One of these plans MUST be your primary insurance. Note: WE DO NOT ACCEPT MEDICAID/MEDICARE. Note: For couples/families, we only offer private pay at $120+/hr. *

Which location would you like to be seen at? *

Abingdon

Pennington Gap

Wise

Telehealth

Messaging Consent

By providing your phone number, you agree to receive phone calls and text messages from Anchoring Hope Counseling, LLC. Message and data rates may apply. Message frequency varies. Reply STOP to opt out.